Earlier this month, WHA and other state hospital associations and medical societies were invited to participate in a Centers for Medicare and Medicaid Services’ (CMS) stakeholder meeting in Chicago. The meeting was an opportunity for WHA and others within CMS Region V to hear from CMS and CMS’s Medicare administrative contractors (MACs) about CMS programs and initiatives.
Among the topics discussed by CMS during the meeting were two recently launched CMS initiatives to reduce regulatory burden on health care providers.
First, the “Patients Over Paperwork” initiative is an effort by CMS to allow providers to spend more time on clinical tasks. According to CMS, the areas that create the most paperwork for providers are payment policy, quality measures, documentation, Conditions of Participation compliance and health information technology. Additional information can be found here: www.cms.gov/Outreach-and-Education/Outreach/Partnerships/PatientsOverPaperwork.html.
Second, the “Meaningful Measures” initiative will examine how to assess health care providers only on those core issues that are most vital to providing high-quality care and improving patient outcomes. According to CMS, the initiative will empower patients and physicians to make decisions about health care, usher in a new era of state flexibility and local leadership, support innovative approaches to improve quality, accessibility and affordability, and improve the CMS customer experience.
“WHA is pleased that CMS is recognizing the need to reduce regulatory and measurement burden on hospitals, physicians and other clinicians who continue to be asked to do more at a lower cost,” said Eric Borgerding, WHA president/CEO. “Unnecessary reporting requirements impact the efficiency of health care delivery overall, and in particular negatively impacts the physician workforce. Addressing that burden on physicians has been and will continue to be a key focus for WHA.”
WHA submitted several recommendations on ways to reduce Medicare’s regulatory and statutory burden to the U.S. House of Representatives’ Ways & Means Committee in August. Those recommendations and comments can be found in WHA’s August 25, 2017, Valued Voice newsletter.
Other topics discussed at the CMS meeting include:
- Laboratory Documentation Errors. During a presentation by a CMS MAC, it was stated that the highest rate of documentation error for health care providers submitting claims is found in laboratory orders. Specifically, the MAC indicated a common documentation error was failure to document evidence of a physician’s intent to order the lab work. The presenting MAC encouraged providers to clearly articulate what they are ordering and why they are ordering the lab work.
- Medicare Advantage. CMS said participation in Medicare Advantage plans has been growing tremendously, with one in three Medicare beneficiaries now belonging to such a plan. In Wisconsin, 39 percent of beneficiaries are enrolled in a Medicare Advantage plan.
- “Targeted Probe and Educate” Initiative. CMS is starting a program called “Targeted Probe and Educate” (TPE), wherein CMS MACs will review the submitted clinical documentation of health care providers with the highest claim error rates or with billing practices that vary significantly from their peers. TPE will involve up to three rounds of review and individualized education. Providers who continue to have high error rates after the three rounds may be referred by the MAC to CMS for additional action. A CMS Fact Sheet on TPE may be accessed at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Targeted-Probe-and-EducateTPE.html.
For more information about the CMS meeting or any of the topics referenced in this article, contact Andrew Brenton, WHA assistant general counsel, at email@example.com or 608-274-1820.